Is He Uninsurable?

[thomaslee]

Does having a pacemaker implant disqualify you for long-term care insurance? A friend of mine had a pacemaker put in 2 years ago. Does this mean he can't possibly purchase any long term care insurance?

[Ohiogirl]

my sister and brother-in-law applied a couple of years ago - he got turned down at about age 75. No pacemaker, so guess possibly age and/or other health conditions? He has arthritis, maybe high blood pressure (not sure) and is overweight.

I'm not sure what their guidelines are. Do some online research too. After all, it's an actuarial decision - they are saying the odds of his needing it are too high to insure, I guess, at least before he pays enough premiums at his age.

[billethkid]

my sister and brother-in-law applied a couple of years ago - he got turned down at about age 75. No pacemaker, so guess possibly age and/or other health conditions? He has arthritis, maybe high blood pressure (not sure) and is overweight.

I'm not sure what their guidelines are. Do some online research too. After all, it's an actuarial decision - they are saying the odds of his needing it are too high to insure, I guess, at least before he pays enough premiums at his age.
LTC is something one starts paying when they are younger to build up an equity with the insurer.
Anybody in their 70's will find the cost per month either prohibitive or not available.

btk

[buzzy]

I think most pre-existing conditions would disqualify an applicant. My wife was almost disqualified just for a medication she was on, until the doctor changed it.

[ijusluvit]

Unlike all other health and life insurance, it seems ironic to me that LTC providers are so fussy. You'd think they'd want the most unhealthy folks they could find, especially those whose illnesses are generally fatal in the shorter term. They approve those who seem to have the best chance at longevity including those who likely could spend years in care facilities collecting on their policies.

[billethkid]

Unlike all other health and life insurance, it seems ironic to me that LTC providers are so fussy. You'd think they'd want the most unhealthy folks they could find, especially those whose illnesses are generally fatal in the shorter term. They approve those who seem to have the best chance at longevity including those who likely could spend years in care facilities collecting on their policies.

Insurers make out by having a mix of clients that vary from those who will never need it to those who do. And as long as those who don't need to claim outnumbers those who do, they can stay in business or raise prices to stay even.

If they would have all clients who need to make a claim they will go out of business......hence the screening to not insure new clients that are 100% certain to be a benefit payout client up front.

We all need to get used to it as there will be more and more of this type screening of health care availability as Obamacare gets implemented and costs continue to soar.

btk

[ijusluvit]

Insurers make out by having a mix of clients that vary from those who will never need it to those who do. And as long as those who don't need to claim outnumbers those who do, they can stay in business or raise prices to stay even.

If they would have all clients who need to make a claim they will go out of business......hence the screening to not insure new clients that are 100% certain to be a benefit payout client up front.

We all need to get used to it as there will be more and more of this type screening of health care availability as Obamacare gets implemented and costs continue to soar.

btk

I think you missed my point here about LTC insurers. You would think they would be attracted to clients who are likely to die sooner rather than later. Many of those folks never live long enough to file claims, or, if they do, only receive benefits for very short periods.

I disagree with your last sentence. As is the case with standard health insurance under the Affordable Care Act, fewer people with pre conditions will be discriminated against when applying for LTC as the Act plays out. I also think it is an unsupportable conclusion that health care costs will continue to soar. Since it is now law, I intend to give it a chance. Already I have reaped great benefits from it and millions of others are, and will continue to, as well.

[buzzy]

Unlike all other health and life insurance, it seems ironic to me that LTC providers are so fussy. You'd think they'd want the most unhealthy folks they could find, especially those whose illnesses are generally fatal in the shorter term. They approve those who seem to have the best chance at longevity including those who likely could spend years in care facilities collecting on their policies.

In their business model, they are looking for people who will pay in for decades without a claim, and then forfeit the account when they can no longer make payments in their old age.

[ijusluvit]

In their business model, they are looking for people who will pay in for decades without a claim, and then forfeit the account when they can no longer make payments in their old age.

I disagree. Your scenario I would think is rather rare. Insurers are looking for clients who pay in for years then die suddenly. That's why I can't understand why they don't approve folks with serious heart conditions for example.

[jimmy D]

Let me see if I can answer your ?. A pacemaker would not automatically cause a person to be rejected with some companies. Other companies, maybe but normally not automatically. Their maybe other health issues, but the ? was re Pacemakers

[Bizdoc]

Many of the companies who originally entered the LTC market have gotten out (they are required to either continue their existing clients of find someone else to take them.)

In many cases, they have found that fewer folks stopped paying than they expected and went on to file claims. Also consider that a typical 3 year, $100 per day policy (which isn't all that much) will pay out $109500 in benefits. Ignoring the cost of administering the policy and the sales commission, they have to collect about that amount to make money. If you are in your 70s, you would have to pay in $15-20K per year. Conditions which indicate that you will need LTC within the next 10-15 years (regardless of age) also won't make sense.

Before you blame the LTC companies, go try to buy life insurance at the same age and/or degree of physical problems. Bet they won't accept you or will charge extremely large premiums.

There's a really good reason that the government realized that they could not make government LTC insurance work. For LTC insurance to make economic sense for companies, they need people to pay premiums for 25 plus years or have very high premiums.

[buzzy]

I disagree. Your scenario I would think is rather rare. Insurers are looking for clients who pay in for years then die suddenly. That's why I can't understand why they don't approve folks with serious heart conditions for example.

Sure. That too. Maybe I was being too cynical.

[valeriesmith]

Nope, having a pacemaker doesn't mean you automatically be decline for long term care insurance. Although most insurance companies will require a couple of more months after installation to go by to make sure there are no cardiac problems or you are in good health, then you may have a good chance of approval in your application.

[dstege]

I am an independent insurance agent who specializes in LTC insurance and Medicare plans. Depending on the company, a pacemaker will not disqualify him if it was originally implanted over five years ago, and as long as there are no additional combination issues. (i.e. diabetes, TIA etc.)

[Golfingnut]

We will see improvements in the entire insurance market with Obamacare starting next month.

In my opinion. Please no flames.

[asianthree]

We will see improvements in the entire insurance market with Obamacare starting next month.

In my opinion. Please no flames.

not sure my sons individual BCBS is going from $77 a month to $188 for the same coverage...

[Golfingnut]

not sure my sons individual BCBS is going from $77 a month to $188 for the same coverage...

My daughter who has recovered from Leukemia (AML) so she will go from no insurance to being allowed to buy coverage.